Tag Archives: There are 72 Hours in a Day

Straight, No Chaser: What Exactly Is AIDS?

October 21, 2017Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease844-SMA-TALK, Acquired Immunodeficiency Syndrome, AIDS, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

This is the second blog in an ongoing series on HIV and AIDS.
After all these years, it’s still an interesting and important enough question to ask and to know how to answer. Most know that AIDS is a devastating disease caused by the HIV virus. However, courtesy of the National Institutes of Health, consider the following:
A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.
I – Immuno – Your body’s immune system includes all the organs and cells that work to fight off infection or disease.
D – Deficiency – You get AIDS when your immune system is “deficient,” or isn’t working the way it should.
S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.

Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (meaning infections not typically present in persons with normal immunity).
You will be diagnosed with AIDS if you have one or more specific opportunistic infections, certain cancers (such as Kaposi’s sarcoma) or a very low number of CD4 cells (a measure of the strength of your immune systems function). If you have AIDS, you will need medical intervention and treatment to prevent death.
Check back to Straight, No Chaser for additional posts on HIV/AIDS, including risk factors and symptoms, progression/complications and treatment.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight No Chaser: HIV Awareness Month – Can HIV Be Eliminated From the Body?

October 20, 2017Hematology & Oncology/Blood Disorders/Cancer, Infectious Disease844-SMA-TALK, AIDS, Blood transfusion, HIV, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

It’s HIV Awareness Month. Have you noticed there’s a lot less chatter about HIV lately? Don’t be lulled into a sense of false security; no, it hasn’t been eradicated. It is still being contracted and is still causing death. Straight, No Chaser will review the latest on HIV in the next few posts.

Looking at the above picture, you would think it shows Ervin “Magic” Johnson donating blood. As most everyone knows, Magic famously retired from the NBA after contracting HIV. As we delve into this Straight, No Chaser, remember two important points.

He never contracted AIDS (we’ll get into the difference between HIV and AIDS in an upcoming post).
He is said to no longer have a detectable viral load of HIV. To paraphrase his words, “I’m cured of HIV.”

So does this mean it’s safe for certain “former” HIV(+) patients to donate blood and engage in activities others who are not HIV(+) can? HIV is a fascinating virus, and the more you know about it, the better off you are, particularly when it comes to protecting yourself from contracting the virus. Several Straight, No Chaser posts have addressed HIV/AIDS, and links are provided below.
In the meantime, consider the following. You’ve had many diseases over your life.

For those of you who have had pneumonia or the flu, did you forever stop kissing once you recovered?
For those of you who have had gonorrhea, syphilis or chlamydia, did you forever stop having sex once you were treated?
For those of you who have had chickenpox, did you forever stop hugging once the virus and rash disappeared?

I bring this points up to point out that at some point, once we truly discover a cure for HIV and actually are successful at eliminating the virus from the body of those infected, it makes sense that you could see someone who was HIV positive donating blood.
However…
That is not a picture of Magic Johnson donating blood. It could be him having blood drawn, or it could be a picture of someone else donating blood with Magic’s head photoshopped on the picture. How do I know this, even without going directly to the source?
In the news…
A case study exists that is about as close to this scenario as it gets. A baby thought to have been “cured” of HIV recently has now been diagnosed with the virus. After being born to a HIV(+) mother, a baby in Mississippi was pre-emptively treated with three antiretroviral drugs for 18 months. Doctors lost track of the infant until she was brought to a clinic for a visit after 10 months of receiving no HIV medication. The team involved found no evidence of the virus in her blood, and declared the girl “functionally cured.” Unfortunately, the virus has now returned. The child, now nearly 5, was found to have high levels of HIV in her blood during a routine visit to the University of Mississippi Medical Center, where she was originally discovered to be HIV(-). Decreased levels of CD4+ cells, the white blood cells targeted by HIV, along with the appearance of antibodies against the virus in her blood, suggest that her remission had come to an end, and that traces of virus remaining in her body had escaped from immune control.
There have now been several cases of cures and relapses. Here’s a bottom line consideration: the earlier that drugs are given, the easier it is for the body to keep the virus in check. However, one should not expect early treatment to completely eliminate HIV.

You may wonder how it’s possible for HIV to become undetectable or to relapse once seemingly “eradicated.” We know the HIV virus can hide away in tissues such as lymphoid and gut cells, as noted in the above picture. Medicines can only reach the virus located in the blood, and if therapy is halted, the virus can emerge from these other locations and relaunch its attack. This explains why most HIV patients need to take antiretroviral drugs daily over the course of their lives,.
The biggest hope for tackling the problem is to find drugs that flush latent HIV out of its hiding places in the body, so all the virus can be eliminated, effectively curing the patient so they don’t have to take more antiviral drugs.
This isn’t much of a surprise. Unlike the examples of disease being fully cured as in the scenarios listed above, other diseases simply go dormant inside the body. The classic example of this is the family of herpes viruses. Many of you are aware that a herpes simplex virus can reappear after decades of being absent. Similarly, chicken pox and shingles – diseases caused by the herpes zoster virus – can reappear after having run their course during the initial infection. At this point it appears that HIV appears to be more like the herpes viruses in this regard than examples of other infections and disease that can be completely eradicated.

Despite theoretically reasonable possibilities about the prospect of receiving blood from someone who had been HIV-positive, it is currently not prudent to do so, even as we know HIV loads can be completely eliminated from the blood of patients. That is not the same as eliminating HIV from the body. Thus, the American Red Cross and other blood donations involved in blood transfusions will not accept donations from anyone ever having been HIV(+).
For those in need of a life-saving blood transfusion, having individuals step up to donate is vitally important. Please consider doing so.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Infection Prevention

October 19, 2017Cardiology/Heart, General Health and Wellness, Infectious Disease, Health Prevention844-SMA-TALK, Behind the Curtain, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

There are things you know, there are things you know but don’t really know, and there are still other things that you think you know that you don’t know at all. When it comes to colds and influenza (both or which are simple to understand, prevent and treat), all of the above apply.
Are you sickly or do you get colds more frequently than others? Respectfully, a big part of that is because you have habits that put you at risk. Common things happen commonly.

Of course this is not an actual photo, but it’s a good depiction of what’s happening. Simply put, most of the day, your hands are pretty disgusting. You handle money that’s been handed hundreds if not thousands of times and never cleaned. You grab handles and door knobs all day long. You cough and sneeze throughout the day, spewing germs into the air to be inhaled by others. And you spend time in the restroom. Your unclean hands contribute to many ailments, including colds, influenza, conjunctivitis (pink eye) and gastroenteritis (vomiting and diarrhea) and skin infections.
The important points are there are simple things you can do to lower your risk for infections. First, you have to stop assuming you know more than you do about basic hygiene and allow yourself to start practicing better habits. For example …

When you sneeze, do you sneeze into your hands or into the air around you? Please learn the habit covering your mouth and nose when you sneeze or cough by sneezing/coughing into your elbow and not your hands.
How often do you wash your hands? You must wash every time you begin to cook, before you eat, after you use the rest room, before you change a diaper and before you apply any topical medicine.
Have you ever noticed how much you keep your hands on parts of you that can become infected by doing so? Keep your hands out of your eyes, mouth and nose, and stop picking at your skin!

Yes, you wash your hands, but do you do so effectively and when you need to? Hand washing must be the easiest and most effective ways to prevent disease. Let’s start with this: from now on, whatever you do to clean your hands, do it for twenty seconds. Of course, antimicrobial soap and water are what we all learned to do way back when. It works! If that’s not available, use hand sanitizer or disposable hand wipes. It that’s not available, just rinse your hands! Be sure to rub your hands vigorously during the process as if you’re trying to get someone off of your hands, because you are!

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Breast Cancer in Men

October 18, 2017Hematology & Oncology/Blood Disorders/Cancer844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

I won’t overstate the case, but you should be aware that breast cancer occurs in men. That said it occurs at a much lower rate than it does in women. I know what you may be thinking, but it’s not that obvious. Both males and females have breast tissue. The big difference is women come equipped with a much greater support of certain hormones that stimulate development of breast tissue. You know this to be true because there are circumstances in which males, either through natural occurrence of abnormally high levels of those hormone levels or by stimulation (such as occurs with certain medicines), can develop noticeable sized breasts (called gynecomastia in non-cancerous circumstances and also present in breast cancer). This Straight, No Chaser offers information you should know to avoid a higher risk of developing breast cancer.

How often does breast cancer occur in males?

It is estimated that in 2014, approximately 2500 men are expected to be diagnosed with breast cancer.
Less than 1% of all breast cancers develop in men.

What are the risk factors for breast cancer in men?

Age: Increases in age correspond to an increased risk. In fact, age in the greatest risk for men. In fact, the average age of men diagnosed with breast cancer is about 68.
High estrogen levels: Estrogen stimulates growth of breasts, both in normal and abnormal circumstances. The following are circumstances that can produce high estrogen levels in men.
- Obesity increases estrogen production.
- Certain conditions or treatment with hormonal medicines that include estrogen.
- Heavy alcohol use can damage the liver, which can result in a diminished ability of the liver to regulate estrogen levels.
- Similarly, other causes of liver disease also result in higher estrogen levels.
- You can also get significant estrogen exposure if hormones are used in the beef cattle you eat.

Klinefelter syndrome is a genetic disorder involving the presence of additional X chromosomes (the “female” chromosome). Men with this syndrome have lower levels of male hormones (androgens) and higher levels of female hormones (estrogen), resulting in a higher risk of developing gynecomastia and breast cancer.
Radiation exposure: Receiving radiation therapy to the chest before age 30 (such as occurs with treatment of Hodgkin’s disease) may increase the risk of developing breast cancer.

A family history of breast cancer or genetic alterations: Other men in one’s family with breast cancer, or a breast cancer gene abnormality also increases the risk of breast cancer. Men identified as having certain abnormal genes, including BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for CAncer) have an increased risk for male breast cancer of 80 times greater than the lifetime risk of men without BRCA1 or BRCA2 abnormalities. The message here is if you have a family history of breast cancer, consider getting checked for the presence of these genes.

If you are a male with significant risks, your next step is to have a conversation with your physician. In case you haven’t seen the rest of the Straight, No Chaser series on breast cancer, use the following links for information on the rest of the story.

Straight, No Chaser: Five Myths Surrounding Breast Cancer
Straight, No Chaser: Even More Myths Regarding Breast Cancer
Straight, No Chaser: The Reach of Breast Cancer and Your Risk Factors
Straight, No Chaser: This is How You Self-Assess For Breast Cancer, Part 1
Straight, No Chaser: How to Perform the Breast Self-Exam
Straight, No Chaser: Signs, Symptoms and Prognosis of Breast Cancer
Straight, No Chaser: Breast Cancer Treatment Options
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Breast Cancer Treatment Options

October 17, 2017Hematology & Oncology/Blood Disorders/Cancer, Medical Treatment, Obstetrics and Gynecology844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

The next to last post in this series on breast cancer is on management. Of course, there is no universal treatment of ‘breast cancer’; everything is based on the specific type of breast cancer and the extent of progression upon diagnosis. Management usually involves a team approach in order to balance multiple considerations, which often leads to different treatment modalities being used together.

My goal today is to offer an understanding for the different components of treatment, not to get into the nuances of individual treatment regimens. I certainly recommend you engage your personal physician and resources such as the Center for Disease Control and Prevention and the American Cancer Society, which will provide you with any and all additional details you may desire.
Breast cancer is treated in several ways, including surgery, chemotherapy, hormonal therapy, biologic therapy, and radiation. Let’s review the basics of each.

Surgery: Under certain circumstances, the cancer has only advanced to a level where it can be surgically removed. Surgical options include cutting out the area affected by the cancer (a lumpectomy), removing the entire breast (a mastectomy), and/or removing the areas where the cancer will drain and spread to other parts of the body (lymph node biopsy/resection). Of course, options aren’t actually quite this simple. Efforts to spare skin and tissue and to retain a cosmetic appearance are important considerations. Sometimes decisions to remove the other breast is made if the risk of breast cancer in that breast is sufficiently high. Additional surgical considerations include breast reconstruction after surgery, which may include one’s own tissue or a synthetic breast implant. These are options to be discussed with a plastic surgeon prior to breast cancer surgery.

Chemotherapy: Chemotherapy is the use of medication to kill or reduce the cancer. Chemotherapy may be given via an IV (into the veins) or by pills. Chemotherapy may be given before surgery to reduce tumor size, after surgery or with other therapy to reduce the risk of recurrence, or as a primary treatment option.

Radiotherapy (radiation therapy): High energy rays can be aimed at the cancer cells in an effort to kill them. Alternatively, radioactive material can be placed in the body.

Hormonal therapy: As mentioned in this post, certain cancer cells are stimulated by hormones to grow. Hormonal therapy blocks cancer cells from getting the specific hormones that assist growth. Different drugs in this class act in a variety of different ways, both direct and indirect, with the same end result of diminishing the ability of hormones to stimulate tumor growth. Yes, this treatment option would be better named hormonal blocking therapy. Hormonal therapy also can be used as a primary treatment option or after other treatment options to reduce the chance of recurrence.
Biological therapy: Biological therapy serves to boost the body’s immune system to better help it fight the cancer. It also is of assistance in addressing immune-reducing side effects other cancer treatments may create.
Targeted drugs: An additional treatment modality is the use of targeted drugs, which attack specific abnormalities within cancer cells. The most notable example of such an abnormality is the presence of a human growth factor receptor 2 (HER2), a protein that helps breast cancer cells grow and survive..

Complications and side effects of breast cancer treatment are plentiful, and they vary based on the treatment given. Surgery carries a risk of bleeding and infection. Risks of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may be altered in texture and may appear swollen. Rarely, damage to the heart or lungs may occur. Common side effects of chemotherapy include hair loss, nausea, vomiting, fatigue and an increased risk of developing infection. Rare side effects can include premature menopause, damage to the heart and kidneys, nerve damage, and, very rarely, blood cell cancer.

The teams of medical, radiological and surgical cancer specialists who treat breast and other cancers do phenomenal work. Do your part in reducing your risks and engaging in practices (breast self-exam and mammograms) that allow for early detection. Remember, the days of increasing rates of breast cancer are behind us, and breast cancer survivors abound, with approximately 2.8 million survivors in the US. You now have the tools to be included in those numbers should (heaven forbid) you find yourself afflicted by breast cancer.

Straight, No Chaser: How to Perform the Breast Self-Exam

October 16, 2017Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, Breast self-examination, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Beginning in their 20s, women should be aware of the benefits and limitations of breast self-exam (BSE). Women should know how their breasts normally look and feel and report any new breast changes to a health professional as soon as they are found. Finding a breast change does not necessarily mean there is a cancer.

A woman can notice changes by being aware of how her breasts normally look and feel and by feeling her breasts for changes (breast awareness), or by choosing to use a step-by-step approach (with a BSE) and using a specific schedule to examine her breasts.
If you choose to do BSE, the information below is a step-by-step approach for the exam. The best time for a woman to examine her breasts is when they are not tender or swollen. Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional.
Women with breast implants can do BSE, too. It may be helpful to have the surgeon help identify the edges of the implant so that you know what you are feeling. There is some thought that the implants push out the breast tissue and may actually make it easier to examine. Women who are pregnant or breastfeeding can also choose to examine their breasts regularly.
It is acceptable for women to choose not to do BSE or to do BSE once in a while. Women who choose not to do BSE should still be aware of the normal look and feel of their breasts and report any changes to their doctor right away.

How to examine your breasts

Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.
Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.

Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast, without missing any breast tissue.
Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.

While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

This procedure for doing breast self-exam is different from some previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman’s ability to find abnormal areas.
I need to acknowledge and thank the multiple sources that continue to compile and disseminate information to the public, including the Centers for Disease Control and Prevention, the American Cancer Society and the Susan G. Komen Foundation. I have used these and other sources over the course of the week to integrate my practices and have distilled their information in many cases. I highly recommend them should you need additional or more thorough information. I welcome your questions and comments.

[youtube=http://www.youtube.com/watch?v=omfbsthDsbc]

Straight, No Chaser: This is How You Self-Assess For Breast Cancer, Part 1

October 15, 2017Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast self-examination, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

When I started this series, my first thought was “Why reinvent the wheel? There is a massive amount of information available on the web about breast cancer, and surely it’s done much better than I could ever do it.” As true as that probably remains, it is also true that much of it is technical and filled with medical jargon. That’s why Straight, No Chaser exists; it’s an effort to break through those types of barriers to understanding. This series on breast cancer is really meant to be straightforward, more easily digestible facts to better empower you. With that in mind, today I’m going to address specific simple steps you should be taking to assess yourself for breast cancer.
First things first. There are a lot of breast cancer self-assessment tools on the internet that ask you questions and then give you a percentage probability that you’ll develop breast cancer. Maybe it’s just me, but that sounds like something that only would serve to increase stress. By my way of thinking, anything other than 0% or 100% is going to increase stress and uncertainty. What I’d like for you to do is to use the presence of the points and risk factors below to serve as talking points with your physician. In other words, seek to self assess with actions to reduce your risk instead of taking a test that spits out a percentage equating to the probability you’d develop the disease.

1. Reduce your risk factors

Discuss with your physician balancing the need for birth control with the use of oral contraceptives.
After you are pregnant, breast feed.
Exercise, and if you’re obese, lose weight.
Limit alcohol intake.
If you’re post-menopausal, discuss with your physician balancing the need for hormone use with your breast cancer risks.

2. Get screened

Learn your body better than anyone else; learn to do breast exams at and after age 20.
Have a clinical breast exam at least every three years starting at age 20, and every year starting at age 40.
Have a mammogram every year starting at age 40 unless your physician places you on a different schedule.

3. Know the signs of concern and prompts to see your health care provider

Lump, hard knot or change in consistency inside the breast or underarm area
Persistent pain, swelling, warmth, redness or discoloration of the breast
Change in the size or shape of the breast
Dimpling, puckering or pulling in of the skin, nipple or other parts of the breast
Itchy, scaly sore or rash on the nipple
Nipple discharge that starts suddenly

In the next Straight, No Chaser, we will go over the breast self-exam in detail.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Reach of Breast Cancer and Your Risk Factors

October 14, 2017Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Even as a physician, I am left to think about the horror of being a woman with a lifetime risk of acquiring breast cancer that’s 1 in 8. The only thing I can think of off-hand and relate to similarly is the risk for trauma being an inner-city minority kid. This risk of breast cancer is compounded by the reality that there is no way to prevent it. Thus, it must be emphasized early and often: risk factor identification and reduction, coupled with early evaluation, detection and treatment are absolutely vital.

Breast cancer is the second most common cancer contracted by American women (after skin cancer), and it is the second most common cause of death from cancer (after lung cancer). More than a quarter of a million new cases will be diagnosed in women yearly, and approximately 40,000 women will die from complications of breast cancer annually (that’s over 100 deaths every day).
In the event the previous information seemed like too much gloom and doom, understand that the tide has been stemmed. After more than two decades of increase, rates of new cases of breast cancer began dropping in 2000 and have stabilized. This is largely thought to be due to declining rates of post-menopausal hormone use in response to results of major research projects. As you may know, such hormone use has been shown to increase the risk of both breast cancer and heart disease.

Speaking of risks, I don’t especially like this part of the conversation because it always comes across as if everything is a risk factor, and there are still controversies about what is or isn’t a risk. As a result, patients end up confused and paralyzed into inaction. Therefore, I’ll mention just enough for you to understand and work with; if you have specific questions on what you’ve heard that I haven’t already addressed in the breast cancer myth posts (Parts I and II), feel free to ask.

There are risk factors you can’t change, like aging, family history and being a woman. Having these risk factors simply means you need to be more diligent in performing self exams and seeking early care for suspicious findings. Now, there are other risk factors you can minimize and are under your control, including the following:

Alcohol use
Choosing not to breast feed
Obesity
Oral contraceptive use
Postmenopausal hormonal therapy

The bottom line is your risk factors don’t cause cancer, and the absence of risk factors doesn’t ensure you won’t have breast cancer. For example, men contract breast cancer as well. What it all comes down to is you must be diligent in performing exams and getting evaluated and treated if something abnormal is discovered. We’ll discuss some of that next.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
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Straight, No Chaser In The News: President Trump Eliminates Low-Income Subsidies for Obamacare

October 13, 2017Public Health844-SMA-TALK, Affordable Care Act, Behind the Curtain, Executive Order, obamacare, President Trump, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

President Trump just removed federal funding for Affordable Care Act (aka ACA, Obamacare) subsidies. Here are five quick answers to questions you should have about this action – and a resource.
1.Exactly what happened – I thought Congress approved the ACA. How can he do this?
The funding in question isn’t the global pot of money that sustains the Affordable Care Act, but supplemental funding under the control of the Executive Branch mean to subsidize (i.e. reimburse) insurance companies for maintaining relatively low rates for lower-income ACA enrollees.
2. Does this mean the ACA is no longer funded?
Actually no. Nothing changes immediately, but you should expect the insurance companies to react to the loss of these subsidies and pretty dramatically raise rates.

3. What will do to my insurance under the ACA?
Over time, expect your rates to skyrocket by an amount proportionate to the revenue lost by the insurance companies. Alternatively and/or additionally, with this and the other assaults on the ACA by President Trump, you can anticipate many insurers leaving the ACA exchanges due to the uncertainty these actions bring to the system. Of course, if this happens, you’ ll disproportionately affected if you’re in the group for whom the subsidies was intended (i.e. lower and middle class) and/or live in the South.

4. Practically speaking, what does this mean (what’s the bottom line on the bottom dollar)?
As noted, almost 60% of marketplace costs are subsidized. Without Congressional action, that could be the amount of rise in your costs if you currently qualify for a subsidy.
5. What can I do to secure my insurance under the ACA?
If you have insurance under the ACA, the enrollment period is now. In a separate action, 90% of the advertising budget for enrollment was eliminated, so you may not know that the ACA enrollment period has been shortened to between November 1 and December 15, 2017. Check at www.healthcare.gov for additional information.
To whom do I complain? Here’s a link for a previous post that lists the local numbers to your Congressmen: https://jeffreysterlingmd.com/2017/09/25/92382/. If you’re going to be affected by this or if you just care, the next step is to have Congress write these subsidies into law instead of them being part of executive actions that get added or eliminated based on which party is in office.
Spread the word!
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
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Straight, No Chaser: Even More Myths Regarding Breast Cancer

October 13, 2017Hematology & Oncology/Blood Disorders/Cancer, Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Continuing from the earlier post with additional myths, well because you have so many questions! In fact, I’m doubling up on what you received earlier in Part I of Breast Cancer Myths.
6. “Breast cancer is preventable.”

Unfortunately, this is not true. All of our efforts are geared toward lowering risks, early detection and effective treatment.

7. The risk of breast cancer isn’t affected by obesity.

Not true. The risk is particularly increased in post-menopausal women with weight gain.

8. African-American women have an increased risk due to hair straighteners and relaxers.

This myth was taken head on and debunked by the National Cancer Institute in a large 2007 study including women with significant use over a 20-year period.

9. Caffeine causes breast cancer.

Not according to the evidence. There’s even evidence suggesting a benefit, but the data on this is just as inconclusive as that suggesting a link to breast cancer.

10. Mammograms increase breast cancer risk due to the radiation load.

The risks of radiation are so relatively insignificant that they’re mentioned as an afterthought compared to the benefits received from early and frequent evaluation.

11. “Tight clothes and underwire bras will make me get breast cancer.”

Not true. Neither has any connection to breast cancer.

12. “I was told small breasts give me less of a chance of having cancer!”

Not true. Larger breasts are sometimes more difficult to evaluate, but that’s not the same as saying the risk of cancer is increased in women with larger breasts.

13. “These lumps I have are ok because I’m breastfeeding.”

The fact you can discover normal changes in your breast tissue doesn’t mean that all lumps discovered while breastfeeding are normal. Get evaluated.

14. “Deodorant and tanning cause breast cancer, don’t they?”

No. Cell phones don’t either. Tanning does increase the risk of skin cancer, but that’s a topic for another day.

15. “I heard having a baby when I’m older increases my risk of breast cancer.”

Well, not just any baby, but having one’s first baby later in life is a significant consideration. Women who give birth for the first time after age 35 are 40 percent more likely to get breast cancer than women who have their first child before age 20.

16. “Breast cancer is a death sentence.”

Most women survive breast cancer. Give yourself the best opportunity to do so by reducing your risks, learning the principles of early detection and getting prompt treatment if ever diagnosed. We’ll focus on these considerations in the next posts.

Straight, No Chaser In The News: New Public Health Consequences & Lessons from Puerto Rico – Leptospirosis

October 12, 2017Infectious Disease, Public Health844-SMA-TALK, Behind the Curtain, Conditions and Diseases, leptospirosis, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

This is a post on a public health matter, not a political one. Please appreciate the difference. Three weeks after Hurricaine Maria rendered the nearly 3.5 million US citizens living in Puerto Rico without normal living conditions, there has been a sudden uptick – a tripling, actually – in the death count. Oddly, the major cause of this surge is not from the over 100 individuals who still remain unaccounted for after all this time. This situation is an illustration of the fundamental roles of government in a society and the consequences that occur when those roles are abdicated or aren’t performed competently.
You may not know that for most of recorded history, diarrhea and dehydration was the world’s number one cause of death. As a public health consideration, the ability to purify water has saved more lives than any other initiative, including antibiotics, immunizations and medical procedures. The situation in Puerto Rico is a stark reminder of what it looks like when citizens don’t have access to clean water; in up to a third of the Puerto Rican population, there still is no access to water, prompting them to drink from local streams and whatever other sources they can access.

The issue here is a disease called leptospirosis. Leptospirosis is a particularly nasty disease that is not uncommon in tropical locations and tends to show up after huge rainfalls. The disease is notable for being spread by drinking water contaminated by animal urine, especially rodents (rats) and even domestic pets that may have gotten into the native water. Symptoms sound like it’s a serious disease; they may include headache, vomiting, high fever, and jaundice (yellow pigmentation). The disease can include liver failure, kidney failure, bleeding from the lungs and infections of the brain. Death rates from this disease alone can reach thirty percent (30%). This is a horrible disease to have and a horrible way to die, even before considering that prevention – simply meaning access to fresh water – is the best cure.

Given that many deadly infectious diseases, including leptospirosis and a host of presumably upcoming mosquito-borne illnesses, can take several weeks to incubate and cause symptoms of a disease, one can assume things will get worse before they get better. In the meantime, there are at approximately 19,000 federal, civilian and military personnel assisting Puerto Rico. Can someone take the time to spread out some water, penicillin and doxycycline, which by the way only costs $1/day?
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
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Straight, No Chaser: Five Myths Surrounding Breast Cancer

October 12, 2017Hematology & Oncology/Blood Disorders/Cancer, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, medical myths, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Before I get into the details of what you need to know about breast cancer, it’s important to clear the table of some of the persistent myths and fears that exist. The disease is tough enough as it is without the fear factor impeding our ability to fight back. Please be patient with me here. If you find these myths ridiculous, then good for you, as it indicates that you’re informed on the matter. Just understand that these are real questions that other physicians and I hear often. Remember, knowledge is power.

1. “If a family member of mine has breast cancer, that means I’ll get it too.”

It is only true to say that women who have a family history of breast cancer have a higher risk of developing it. Overall, only approximately 10% of women diagnosed with breast cancer have a family cancer, and most women with breast cancer have no family history. In other words, a family member with breast cancer isn’t a life sentence for you, and it shouldn’t stop your efforts to lower your other risks and focus on early detection and treatment.

2. “All lumps in my breast are breast cancer.”

There are two important points for you to remember. First, any persistent change in the breast or armpit (axilla) should not be ignored. Remember, I will be stressing the importance of early evaluation for the purposes of detection. That said, only a small percentage of breast changes represent cancer (about 80% of lumps are benign). The really good news is if you learn and perform consistent breast exams, you will detect these changes earlier than anyone else and very often early enough to make a difference.

3. “Men don’t get breast cancer.”

Unfortunately, I know this not to be the case within my family. Annually, there are over 400 breast cancer deaths among men from over 2000 new cases being diagnosed. Men should pay attention just as women do because unfortunately, in part due to the delayed detection, the death rate of breast cancer in men is higher than in women.

4. “I heard breast implants cause cancer.”

No. There’s no increased risk with breast implants and breast cancer. However, you can legitimately say implants sometimes obscure the view of possible cancer on a mammogram.

5. “The risk of breast cancer is always 1 in 8.”

Actually it’s 1 in 8 during a woman’s lifetime. The important distinction is the risk increases as one ages, from 1 in 233 in a woman’s 30s up to 1 in 8 across the board by age 85.

Straight, No Chaser: October is Breast Cancer Awareness Month

October 11, 2017Obstetrics and Gynecology, Health Prevention844-SMA-TALK, Behind the Curtain, Breast cancer, National Breast Cancer Awareness Month, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Breast cancer disturbs me deeply, and if it doesn’t affect you as well, you haven’t been paying attention. One in eight women will be diagnosed with breast cancer in their lifetime. It’s more likely than not that every single one of us has been affected by this, either directly or through a friend or family member.

Breast cancer is different. We’ve found the way to eradicate certain cancers and have made remarkable progress on others. Aside from the hereditary component, breast cancer seems so…random, so dehumanizing and so debilitating to so many. Unlike so many of the things I address as an emergency physician, breast cancer isn’t like trauma, STDs and many other conditions, where one is often directly suffering the consequences of their behavior. It is vital that you appreciate the need and value for early detection to give yourself the best possible chance for the best possible outcomes. I’ll be discussing all these considerations in detail throughout the week.

I appreciate the sentiment behind a National Breast Cancer Awareness Month, but if I could offer you anything on this, it would be a plea to be ‘aware’ every month, and use this month as a (re)commitment to take basic steps that will reduce your risk, a charge to maintain steps for early evaluation and a prod to point you toward prompt treatment if and when needed. In fact, those three areas will be the topics of my next few posts. In the meantime, please share this or other information about breast cancer with any and all females in your life. I also hope you choose to engage your family, friends and others in conversations geared to improving breast cancer awareness. Odds are many of them have been or will be affected by breast cancer.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Artificial Sweeteners

October 10, 2017Diet and Nutrition844-SMA-TALK, artificial sweeteners, Equal, saccharine, splenda, Sterling Medical Advice, SterlingMedicalAdvice.com, stevia, Straight No Chaser, sucralose, There are 72 Hours in a DayJeffrey Sterling, MD

It’s always struck me as somewhat odd when people approach me with concerns about sugar substitutes. What I mean by that is my first response is something akin to “Whatever your concerns are, the sugar substitute is going to be safer than using the sugar you’ve been using.” This Straight, No Chaser answers some basic questions about the use of the various artificial sweeteners. The considerations discussed below assume use of artificial sweeteners in a roughly equivalent manner as table sugar (i.e. in the same amounts).

When would I want to use an artificial sweetener?
Let’s start with the premise that you would do well to find an alternative to your routine table sugar (sucralose). Just because you’re used to it doesn’t mean it’s safe. The increased calories and subsequence risks for obesity, diabetes and other medical conditions are well and extensively described. Artificial sweeteners are attractive alternatives to sugar because they add essentially no calories to your diet. Also, if you’ve used artificial sweeteners at all, you likely know you need only a fraction of the amount of sugar you would normally use for sweetness.

What are the health benefits?
There are three potentially big benefits to using artificial sweeteners.

Dental: Artificial sweeteners don’t contribute to dental decay and cavities.
Weight control: Artificial sweeteners have virtually no calories. In contrast, each gram of regular table sugar contains 4 calories, and a teaspoon of sugar contains about 16 calories. In practical terms, one 12-ounce can of a sweetened cola contains 8 teaspoons of added sugar, or about 130 calories. If you’re trying to lose weight or trying to prevent weight gain, using artificial sweeteners instead of higher calorie table sugar may be an attractive option.
Diabetes control: Unlike sugar, artificial sweeteners generally don’t raise blood sugar levels (because they are not carbohydrates). Always check with your doctor or dietitian about using any sugar substitutes if you have diabetes. You’ll likely be advised that artificial sweeteners may be a good alternative to sugar if you have diabetes.

What about the possible health concerns with artificial sweeteners?

Many people remember that once upon a time (i.e. in the 1970s), saccharin was linked to bladder cancer in lab rats. Some have been skeptical, if not fearful, of artificial sweeteners ever since. The fact of the matter is, according to the National Cancer Institute and other health agencies, there’s no compelling scientific evidence that any of the artificial sweeteners approved for use in the U.S. cause cancer or other serious health problems. Saccharin doesn’t even carry a warning label anymore. Furthermore, numerous research studies confirm that artificial sweeteners are generally safe in limited quantities, even for pregnant women. You should be comforted by the fact that the Food and Drug Administration (FDA) regulates artificial sweeteners. They all have been extensively reviewed and approved prior to public release. Furthermore, the stated “acceptable daily intake (ADI)” for artificial sweeteners (i.e. the maximum amount considered safe to consume each day over the course of your lifetime) is intended to be about 100 times less than the smallest amount that might cause health concerns.

Bottom line: Moderation is key because artificial sweeteners are attached to foods. Just because a food is marketed as sugar-free (having artificial sweeteners) doesn’t mean it’s free of calories; there are other ingredients in foods that likely contain calories. A common and realistic fear of artificial sweetener use is folks tend to consume more than they previously may have. This can lead to weight gain! Another consideration is if you’re getting your artificial sweeteners in processed foods, these generally don’t offer the same health benefits as whole foods such as fruits and vegetables.
There are a million articles from less renown sources that speak to ominous effects of sugar substitutes. Remember that virtually every substance known to man has adverse effects if used excessively. Based on the current medical literature, both on a relative and absolute scale, you should feel no concern with replacing your table sugar with sugar substitutes.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: What To Do If Your Tooth Comes Out

October 9, 2017General Health and Wellness, Dental844-SMA-TALK, Behind the Curtain, dental emergencies, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

There’s nothing pleasant about having a tooth fall out of your mouth (aka avulsed tooth, dislocated tooth). Whether from trauma (e.g. a punch or other facial injury, a fall) or dental disease (e.g. gum or tooth disease), there are cosmetic and practical concerns with not having teeth in your mouth. Additionally, there’s no tooth fairy for adults.

The question in real time is “My tooth just fell out. What should I do?” The answer depends on your age and health; the tooth might be able to be placed back into your socket. Today’s Straight, No Chaser gives you tips on how to increase the chances that replantation will be successful.
Which teeth are eligible? Baby teeth (those in children age eight and younger) are usually not replaced. Usually adult teeth can be replanted if appropriately handled.

What can I do?
Follow these steps:

Act promptly. You’re losing 1% probability that replantation will be successful with each passing minute.
If possible, get to a dentist. If you can’t reach a dentist, get to the closest emergency room.

Only hold the tooth by its chewing edge (the crown) as shown in the picture, not by the other end (the root). Holding it by the root will damage the ligaments needed to make connections between the tooth and the mouth. Do not brush, clean or scrape the tooth off in an effort to remove dirt, especially at the root. Do not apply alcohol or any other abrasive solution (e.g. peroxide).
If it can be done safely, placing the tooth back in the socket from which it came is the right thing to do. If you do this, it needs to be level with other teeth, and you must be positive that you aren’t in a situation that might lead to you swallowing it. This can be facilitated by place a piece of gauze or a tea bag on top of the tooth, biting down and keeping your mouth closed during the trip.

If you have a small container, you can place the tooth in it. Then cover the tooth with a small amount of saliva or whole milk, and put this container in another container that has ice in it. Do not place an avulsed tooth directly on ice.
Alternatively you can just place the tooth directly into a small cup of milk or saliva.
As still another option, there are actually commercially available tooth-saving storage devices set up for this purpose.
If you don’t have a container, your best bet is to carry the tooth in your mouth, keeping it under your tongue or between your lower lips and gum. The same precautions about swallowing the tooth still apply here.

How do I prevent losing a tooth?

Avoid fights. It’s not worth losing a tooth.
When playing any contact sport, wear a mouth guard. They work.
Avoid chewing on bones, stale bread tough bagels and other hard foods, especially if you’re older or have either gum or dental disease.
Wear a seatbelt.

There is a fair to pretty good chance your avulsed tooth is accompanied by damaged nerves or a fractured jaw. The force required to traumatically dislodge a tooth is significant. Get seen ASAP if this happens, especially if you’re bleeding, can’t close your jaw or if you became unconscious.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Sensitive Teeth

October 8, 2017Dental844-SMA-TALK, Behind the Curtain, hypersensitivity, root canal, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

What goes through your mind when your teeth hurt (other than whether or not all of that Valentine’s Day candy is worth it)? Is it fleeting or constant? Are you easily agitated by hot and cold stimuli alike? Do you have problems even when you brush and/or floss? These are some of the circumstances those with sensitive teeth have.

Now you would think this is pretty straightforward, right? Your teeth hurt, you stop doing what is making them hurt, and you go to get them evaluated. Unfortunately, it’s never that simple. Sensitive teeth can be a precursor to disease developing, or it can be a symptom of disease that’s established. Examples of causes of sensitive teeth include the following.

Cavities (holes in the teeth)
Decayed and/or fractured teeth
Exposure of the tooth root or nerve endings supplying the teeth
Gum disease
Worn tooth enamel or fillings

A common thread exists in the above listing. Enamel protects healthy teeth at the level of your crowns—the part above the gum line. Cementum protects the tooth root (which lies below the gum line). Underneath both the enamel and the cementum is dentin, a layer of the teeth less dense and more hollow. When the levels of protective covering are eroded and dentin is exposed, foods and other substances may penetrate and reach the nerves within your teeth through these more hollow areas. The increased propensity for this to happen is experienced as hypersensitivity.
Your first challenge is not to let things get out of control. In the event you’re experiencing dental pain for any reason, it needs to be evaluated and addressed. If it’s truly hypersensitivity, your dentist has several options at his or her disposal.

Desensitizing toothpaste contains compounds that help block transmission of sensation from the tooth surface to the nerve. Several applications are usually required before the sensitivity is sufficiently lessened.
Fluoride gel can be applied in the dentist’s office. This serves to strengthen tooth enamel.
Placement of a crown, inlay or bonding may be used to correct a flaw or decay that results in sensitivity.
If gum tissue has been lost from the root, a surgical gum graft will protect the root and reduce sensitivity.
If sensitivity is severe and persistent and cannot be treated by other means, your dentist may recommend a root canal to eliminate the problem.

Straight, No Chaser: How’s Your Dental Hygiene?

October 7, 2017Dental, Health Prevention844-SMA-TALK, Behind the Curtain, dental emergencies, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

If you ignore your teeth, they’ll go away.

Working in an emergency department is interesting for many different reasons. One thing in particular I’ve noticed over the years is how oblivious some people are to their smiles—especially their teeth. We see it all: loose teeth, missing teeth, broken teeth, infected teeth, sensitive teeth, erupted wisdom teeth, gingivitis, bad breath, dental infections (especially abscesses), things stuck in the teeth, mouth cancer, yeast infections, rashes inside the mouth and other conditions. The mouth is the gateway to the body. Through it, you introduce many substances that can infect or otherwise damage you. Clinically, the appearance of your mouth, gums and teeth are often a direct statement about how well you care for the rest of your body.
You would think dental hygiene is an especially difficult proposition, but it’s actually quite simple. According to the American Dental Association (ADA), all you really need to commit to good dental hygiene is less than five minutes at a time, at least twice a day. Surely that’s not too much to ask of yourself for yourself, is it?
Let’s identify three sets of conditions you should be prepared to address with your activities. Each measure contains simple tips and habits you should employ to keep your smile making the right kind of introduction.
1. Prevention and self-maintenance

Brushing and flossing keep your gums and teeth healthy by removing plaque and food particles that can serve as a source for infection and tooth decay. Here are your essentials.

Brush for two minutes at a time.
Brush at least twice a day and preferably after each meal.
Flossing is important. There are particles that collect under the gums and between the teeth that your toothbrush can’t reach.

Avoid the stainers. Tobacco products (e.g., cigarettes, chewing tobacco and cigars), excessive red wine and coffee contain a high quantity of very strong chemicals that stain and damage your teeth. Cranberry and grape juices also may stain teeth if consumed in excess. Besides cosmetic considerations, the staining isn’t the problem as much as fact that the chemicals causing the staining are also damaging your teeth and gums.
2. Prevention and professional maintenance

Do you have a dentist?

Regular dental checkups are very important for the ongoing maintenance of your teeth and the early identification of dental problems—before excessively expensive and painful options are needed.
Dental exams provide an opportunity for identification of several medical conditions and diseases whose symptoms can appear in the oral cavity (mouth).

3. Recognizing possible dental emergencies

It is simultaneously understandable and befuddling that patients go without dental care as long as they do. By the time they come to the ER, invariably, some of these symptoms have been present and were ignored. If you’re experiencing the following symptoms, you’d do well to see the dentist early, before you end up in the ER.

Your teeth have become sensitive to hot or cold stimuli.
Your gums are swollen and/or they bleed with brushing, flossing or eating.
You have continually bad breath or bad taste in your mouth.
You have difficulty chewing or swallowing.
You have pain or swelling in your mouth, face or neck.
You have spots or a sore that doesn’t look or feel right in your mouth and it isn’t going away.
Your jaw sometimes pops or is painful when opening and closing, chewing or when you first wake up.
You have an uneven bite.
Your mouth is becoming unexplainably drier than normal.
You have a medical condition such as diabetes, cardiovascular disease, eating disorder or are HIV positive with new dental problems.
You are undergoing medical treatment such as radiation, chemotherapy or hormone replacement therapy with new dental problems.

Upcoming Straight, No Chaser posts will evaluate individual dental emergencies.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Battered Woman Syndrome and Why Victims Stay In Abusive Relationships

October 6, 2017Mental Health, Public Health, Sports Medicine, TraumaAmazon, Feel free to ask your SMA expert consultant any questions you may have on this topic. Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterl, iTunes, LLC · Powered by WordPress, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, There are 72 Hours in a DayJeffrey Sterling, MD

Domestic violence has been in the news quite a bit lately, and among the many questions asked, perhaps the most frequent is beguiling to many: “Why do the victims stay in the abusive relationship?” Today’s Straight, No Chaser discusses the Battered Woman Syndrome (BWS). In recent Straight, No Chaser posts, we have looked at several aspects of domestic violence, including the following (click the links to access the posts):

As suggested by the name, many more women are victims of domestic violence and battered woman syndrome than men, although men are also victims of physical, psychological and sexual abuse. As viewed by the psychiatric community, BWS is a subcategory of post traumatic stress disorder (PTSD).
To be clear, this is about power, control and violence. Both the symptoms produced and the treatment offered revolves around 1) identifying and breaking the perpetrator’s control and 2) identifying and changing the environment fostering the victim’s previous inability to escape that control. In some men, the need to exert power and to control women simply exists (whether learned as a child or innate), and abuse is how it is expressed. Until battered women take back some control over their lives, some will continue to suffer from the consequences of this disorder.

Let’s answer a few commonly asked questions about battered domestic partners.

What are the symptoms of battered woman syndrome?

Avoidance behavior and emotional numbing (usually expressed as depression, dissociation, minimization, repression and denial)
Body image distortion and/or physical complaints resulting from psychological stress
Disrupted interpersonal relationships resulting from the abuser’s power and control measures
Hyperarousal (jitteriness) and a high level anxiety
Unwanted, intrusive recollections of associated traumatic event(s)
Sexual intimacy issues

What is the treatment approach and plan for victims of BWS?
The survivor therapy empowerment program (STEP) is the central approach to helping BWS patients recover.

Labeling and validation of abuse and safety planning (i.e. identify it, name it, and develop a plan for ongoing safety)
Cognitive restructuring (i.e. mentally free the victim from the willingness to accept the abuse and conditions producing the abuse)
Recognizing danger and building strengths
Reducing stress and PTSD symptoms
Learning about the existing cycle of violence (between behaviors and abusive actions)
Identifying and treating additional components of post-traumatic stress disorder
Calculating and adjusting for the impact on children
Grieving relationships and letting go
Emotional re-regulation (i.e. reprioritizing your emotional investments)
Rebuilding new relationships
Learning to appropriately allocating your pleasing behaviors and compliance issues
Termination (i.e. ending association with negative behavioral and individuals)

Why do women stay?
It really is both a complicated and easily understood answer. There are many components to why victims stay and what’s necessary for them to escape, including any or all the following.

Domestic violence involves violence. Death is an option. This option becomes most viable when victims are escaping or have left, as the perpetrator no longer has control of the situation and fears the impending consequences. Clearly the victims understand this as well.
The dependency on the abusive environment often precludes leaving. Not having an escape plan, a safe haven or sufficient support are prohibitive to removing yourself from an abusive environment.
Battered women syndrome includes a certain mentality of invested love, hope and fears of loss that victims often do not care to easily relinquish.
In many cases BWS involves children, which further enhances the emotional investments and sense of impending loss, by both perpetrator and victim.

If you find yourself in such an environment and manage to escape, speak early, often, loudly and broadly about your prior situation. It will generate the various levels of support needed to prevent a relapse or recapture. Given that between a quarter to a third of women are or have been in an abusive relationship, someone you know is at risk. This is so prevalent that most emergency rooms now screen every woman for domestic abuse. Take the time today to ask your friends and loved ones if they need help. If you are that person, get help while you can.

The National Domestic Violence Hotline number is 1-800-799-SAFE (7233). You should definitely memorize it, but I hope you never have to use it. Unfortunately, the odds reveal that many of you will. I have attached a related TED talk on this same topic by a survivor.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Domestic Violence – How to Get Out of an Abusive Situation

October 5, 2017Mental Health, Neurology, Trauma844-SMA-TALK, Behind the Curtain, domestic violence, national domestic violence hotline, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Remember: You are not to blame, and you need not face domestic violence alone.

With the recent attention in the news on domestic violence and debates about responses and responsibility, I thought this post would refocus attention on where it needs to be: getting the abused individual safely out of harm’s way.
This is the third in a three-part series on domestic violence. The first post focused on the scope of domestic violence. The second post focused on risk factors and identifying whether your situation places you at risk.
When it comes to domestic violence, it is the immediate danger that can make it difficult for you to figure out the safest next move. Thus, it becomes important to know in advance the how and where of your escape plan.
Escaping the Crisis
If you are in a crisis situation, first make sure you and any other family members (e.g., children, parents) are safe. Leave the scene immediately, and find safe haven wherever it exists, such as an emergency shelter or the home of a friend or family member. You can find a shelter by calling (800) 799-SAFE. Call the police if you think you can’t leave home safely or if you want to bring charges against your abuser. If possible, take house keys, money and important papers with you. The staff members at emergency shelters can help you file for a court order of protection.
Be advised: Do not use drugs or alcohol at this time, because you need to be alert in a crisis. Even while you do what you feel you must do, be aware that use of weapons (even in a life-saving defense) will likely complicate and confuse matters.
If you can, just in case, plan your escape. Establish escape routes and a safe haven. Secure important documents.
Where Do I Go If I’m Mentally or Physically Hurt?
Talk to a physician or get to an emergency department. We are prepared to check you for any life-threatening consequences to your abuse, treat any medical issue, provide mental health support and make referrals. Should you find an emergency shelter, counseling and support groups are available for you and your children.

Dealing With Your Abuser
Your primary focus should be on finding help for yourself and escaping the danger.

First things first: Call the police if you believe that you are in danger.
Call the National Domestic Violence Hotline 1-800-799-SAFE (7233), your state domestic violence coalition and/or a local domestic violence agency. Seek out and speak with a family law advocate at your local crisis center. He or she can help you press charges against the perpetrator, file a temporary restraining order and advise you on how to seek a permanent restraining order.
Don’t keep your circumstances hidden. Discuss them with a physician, nurse, therapist, friend, family member or spiritual advisor when you first believe yourself to be in a dangerous environment. Be careful to avoid advice that attempts to place you back in harm’s way or to do anything that is not best for you or your family. Don’t let someone talk you into doing something that isn’t right for you.
Document any attempts at contact by the perpetrator. Save any new messages (especially threatening ones).
Keep photographs that show any injuries you received. You will need this should you pursue legal action (e.g., press charges or file a restraining order).
While it’s best to avoid the abuser completely, if you must meet to exchange documents or personal effects, do it in broad daylight where plenty of people are around, particularly those you know. It is preferable to have someone else make those exchanges, if possible.

After You’ve Escaped
You need to remain detached from your former situation as much as possible and implement changes in your life. Consider these following tips:

Establish a new routine. Someone looking for you will look for you in places you’ve frequented in the past.
Maintain an escape plan in your new location. It may seem counterintuitive, but avoid a route that takes you through areas with potential weapons – your attacker may end up with them instead of you.
Change your mobile or home phone number immediately after you’ve escaped the situation.

Being subjected to repeated domestic violence can extract a devastating psychological toll. Although many domestic violence survivors do not need mental health treatment, and many symptoms resolve once they and their children are safe and have support, for others, treatment is a major component of their plan for safety and recovery.
Again, the National Domestic Violence Hotline 1-800-799-SAFE (7233). You should definitely memorize it, but I hope you never have to use it. Unfortunately, the odds reveal that many of you will.
I hope you have found the information in this series helpful. Good luck. Feel free to contact your Sterling Medical Advice expert consultant with any questions you have on this topic.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser In the News: Again with the Gun Violence?

October 4, 2017Public Health, Trauma844-SMA-TALK, Behind the Curtain, Gun violence, Las Vegas Massacre, Sterling Medical Advice, SterlingMedicalAdvice.com, Straight No Chaser, There are 72 Hours in a DayJeffrey Sterling, MD

Why are we being willfully ignorant? This public health conversation is not about the right to bear arms. It’s about failure to address a major cause of death. Injury from trauma is the number one cause of death in the United States between ages 1-44, according to the Centers for Disease Control and Prevention. That’s right, if you’re going to have a premature death, various forms of trauma are more likely to be the cause than a heart attack, stroke, cancer, infection or poisoning.

Among these causes of death, the biggest causes are motor vehicle collisions (MVCs) and homicides/suicides from firearms. Now if you thought about it, you’d realize that preventive measures are everywhere for almost every major cause of death – except firearms. Can you imagine us being as passive with prevention of breast cancer or MVCs are we are with guns? Furthermore, look at how we contort ourselves to address every component of suicide prevention except the fact that guns are the most commonly used method to commit suicide – in fact, it’s twice as frequently used as the next most common cause. Now think of how different the conversation would be if firearms were managed in the same manner that your ability to drive a car is – just as is related to safety considerations.

The right to bear arms should be equated with the right to be stupid. Are we so mentally deranged that we’ve normalized the means for our death as the nation’s highest priority, for which every other consideration of our national existence must accommodate? Why exactly is this such a sacred cow? What is America so alone among the rest of the world in assigning such value to the immediate availability and personal possession of agents of death?
We’ve previously addressed issues of gun deaths in these Straight, No Chaser posts:
Straight, No Chaser: The Role of Gunshot Wounds in a Nation at War with Itself
Straight, No Chaser: Your Questions About Gunshots and Stab Wounds
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook @ SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

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